The causes of paraphilia are uncertain, but are believed by psychologists to be attributable to several potential factors. The first, and most difficult to quantify, is the simple fact that some people are “wired” a certain way; in other words, their brains contain an unknown physical characteristic that causes them to process information a certain way, and to have thoughts or fantasies that are outside the realm of what most civilizations consider normal. This is not, obviously, something that can be diagnosed through imaging of the brain, but through a series of tests, including monitoring the reactions of patients to certain images projected in front of them, as well as through questionnaires and interviews. Assuming a degree of honesty on the part of the patient, much can be determined from the answers he or she (usually a male) provides.

Additional causes of paraphilia are believed to include mental conditioning by subjecting impressionable – usually young – children to behavior and/or images that convince the child that the deviant behavior in question is “normal” and acceptable. A child repeatedly exposed to instances of deviant behavior will often learn to associate that behavior with normal human conduct. It is well-established that sexually abused children sometimes grow up to be sexual abusers themselves.

Possible treatments for paraphilia include a combination of protracted and sometimes intense therapy combined with pharmaceutical prescriptions intended to alter the individual’s hormonal balance. The journal Psychology Today reports that “a class of drugs called antiandrogens that drastically lower testosterone levels temporarily have been used in conjunction with [psychoanalysis, hypnosis, and behavior therapy]. The journal goes on to note that “hormones such as medroxyprogesterone acetate and cyproterone acetate decrease the level of circulating testosterone thus reducing sex drive and aggression.”

Depending upon the underlying cause of the paraphilia, different therapeutic strategies would be employed for each individual. When the cause is an abnormality in the neurological make-up of an individual, the emphasis would likely be on medications. In cases where mental conditioning caused by excessive exposure to deviant behavior created the condition, then psychoanalysis and behavior modification, combined with medications, would be more likely to have success. In any event, treatment is a long-term process and, as individuals develop resistance to certain medications, new drugs or combinations of drugs have to be prescribed.